Daniel Hell

Soul Hunger

The Feeling Human Being and the Life Sciences

368 pages, ISBN 978-3-85630-730-1, Daimon

Modern psychiatry attributes psychological suffering to functional disturbances of the brain. This approach, based on precise outside observation combined with advanced technology, renders the individual ever more an object of examination and treatment. The author of Soul Hunger adds another dimension by arguing for a differentiated perception of inner experience. His basic hypothesis: the more high tech there is, the more important high touch becomes. The more psychiatry is influenced by neuroimaging and neurogenetics as a viewpoint from the outside, the more an affected individual needs inner groundedness, a mindful inclusion of personal experience. Daniel Hell explains that many psychological disturbances can be attributed to contradictions between a self-image and actual experience. This tension-filled discrepancy is illustrated in detail with examples from the development of depressive, anxiety and adjustment disorders. At the same time, it is shown how it is vital, in dealing with tensions, to carefully perceive arising feelings and thoughts.

This book is divided into three parts. In a first historical section, a short history of the soul and its treatment (psychiatry) is presented. The second part consists of a conceptual description of the necessity of an inner and an outer point of view for understanding and treating psychological disturbances. The third part describes the practical application of this approach to some of the most frequent mental disorders, such as depression.

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Book review

SCHWEIZER ARCHIV FÜR NEUROLOGIE UND PSYCHIATRIE 2011;162(8):338

Edgar Heim, Hünibach

www.sanp.ch | www.asnp.ch

Daniel Hell (past chair of psychiatry at Burghölzli university hospital Zürich) has written a fascinat­ing book which throws down a genuine challenge to the reader. It confirms his longstanding conviction that the soul (or the ‘soulish’ as the translator put it in his demanding task of finding adequate terms in English) must be given equal importance to any other concept when discussing psycholo­gical terms. The author’s rich experience and broad outlook allow him to ask implicit questions, such as: what philosophical ground is pertinent, what epistemology in psychiatry and psycho­ therapy is correct, how pertinent are taxonomy or terminology – or what ‘soul should be breathed into natural sciences’. Maybe the author wishes to answer all these questions at once – and even add something more – his personal conviction.

His thinking is in the European tradition as it evolved up to the middle of the 20th century, when psychological assumptions were dominated by German psychiatry. We are confronted here with another round of the perpetual ‘body­-soul debate’. Up to our own day German psychiatry has striven to differentiate explaining of mental phenomena from understanding or describing or classifying them. The Anglo­-Saxon reader, however, may be reminded of another debate tak­ ing place in the second half of the 20th century within medicine, viz. how can disease best be explained: as a pathophysiological process (dis­ ease) or as human experience (illness) or as a social construct? This dispute was resolved by George L. Engel’s concept of ‘bio­psycho­social medicine’, which assigns equal importance to the individual perspectives. Now that the neuro­sciences are flourishing, psychiatry and psychol­ogy have an equal task to resolve: what perspec­tive can best explain human behaviour: objective determinism, subjective understanding or psycho­ pathological description? Daniel Hell sees himself clearly as an advocate of the ‘soulish’, of empathic understanding – without ignoring the other points of view. He proceeds as follows: in the first part of the book he describes – on the basis of his rich philosophical and cultural experience – how the term ‘soul’ has developed in the course of history. Out of this follows a brief history of psychiatry, in which he refers to a similar debate of the early 19th century when so­called ‘Psy- chiker’ (‘soulminded’ scholars) argued in favour of the psyche, whereas the so­called ‘Somatiker’ were convinced that mental illness arises from somatic factors. Daniel Hell also asks what is meant by ‘normal’, and shows how misuse of the concept can lead to criminal acts – such as when the National Socialists under Hitler euthanised men­tally sick people. He summarises this part by documenting that the term mental illness was first understood in the 19th century as a disorder of the brain or reason, was seen later as a disorder of adjustment, while more recently illness has been primarily understood as suffering (as contrasted to wellbeing in the WHO norm).

In the second part of the book the author unfolds his favourite idea of a ‘personal concept of the soul’. Here the emphasis is on the first-­person perspective which is beyond pure subjectivism. It is opposed to a reductionistic objectivism which takes a third­-person perspective and limits itself to bodily processes. Psychological acts are “in the nature of a living body. This body (Leib), however, cannot be seen as merely an object, but must be viewed as an acting, experiencing, and feeling organism”, as the author describes it. The first­ person perspective assumes that psychological processes cannot be detected from the outside. That is why language acts as an agent between inside and outside. Daniel Hell respects the con­tribution of neurosciences in mediating such processes as memory or language. But he doubts that neurosciences can ever adequately describe complex phenomena such as consciousness or self­esteem. This discourse leads to what the author calls a view of illness that is both personal and focused on the patient’s experience. It is not behavioural disorders but modes of emotional experience which can best explain the patient’s suffering. He proceeds to demonstrate this in classic clinical disturbances such as anxiety, sadness and disgust. On the basis of his rich clinical experience, the author uses pertinent vignettes as examples of patients’ suffering, some of them based on writers’ autobiographies. Here the author’s thinking is convincing, when he demonstrates how his theoretical concepts can be applied in the clinical act.

The third part of the book, called ‘practical application’, actually continues these considera­tions. It addresses first ‘shame and shaming’ (in the sense of narcissistic disorders), followed by different forms of depression as examples of ‘dis­couraged feeling’. These clinical aspects are sup­plemented by therapeutic recommendations. In a final chapter major issues are taken up again.

It may be evident by now – having read this summary and acknowledged some of the author’s terminology – why the book has been described as challenging. On the one hand, the reader must be open to ideas that are broad in scope. On the other hand the author often changes the level of argument, thus forcing the reader to adjust to the respective terms. The author purposely chooses many original terms to argue in favour of his ‘personal concept of the soul’ in accordance with a first-­person perspective. Here he is in line with some of the philosophers quoted, such as Pauen, Searls or von Weizsäcker. But this cannot undo the epistemological fact that within clinical activ­ity and research there are different points of view or levels which ask for their proper terms. Hence the vocabulary describing scientific processes must be that of the natural sciences, psychology or sociology – depending on the questions asked. First­person or third­person perspectives in such a concept are not opposed to each other but are to be understood as complementary. This is the way to avoid the risk of committing an ‘error of categories’, as it has been called by the philoso­pher Peter Bieri. He warns that different levels of argument should not be played off against each other. To connect arguments of different levels with each other, however, remains a very tricky matter: one does not correlate phenomena with each other, one only connects statements about phenomena.

It is true that in this time of enormous progress in the neurosciences there is a danger of ‘eliminative materialism’. Hence this may be the moment for advocates of different arguments, such as the ‘soul’ or subjectivism, to step forward. That is what makes Daniel Hell’s book so valuable. This ambitious translation may also help to build bridges between European and Anglo-­Saxon thinking, as reflected in the ongoing ‘body­-soul debate’ and illustrated recently in issues on con­sciousness or free will.

Review of Daniel Hell’s Book: Soul Hunger. The Feeling Human Being and the Life Sciences

Daniel Hell has written an uncommon book in breadth and depth of its scope. His book is an excellent analysis of the interface between professional psychological understanding of intrapersonal processes and the world of spirituality.

Hell presents aspects of the understanding of the “Soul” in Judaeo-Christian Scriptures, ancient Greek philosophy as well as the antique Asian cultures. He also gives a broad overview of the development of psychiatry, psychology and medicine until the present time. He describes and analyzes the concept of the “Soul” from archaic times until modern times. The “Soul” has disappeared from the centre of human ideas in modern times, while having been presented as a living being, e.g. a bird, at the dawn of history. Correspondingly, phenomena attributed to “soulish” processes in former times, are nowadays considered material events such as biochemical cascades of the central nervous system. Hell uses the examples of depression, anxiety and shame, which all oppress emotional life, as appearing with a distinct picture of the suffering in each suffering person, even if the general diagnosis is the same. Thus, knowledge of altered functions of the brain do not adequately explain the distinctness of suffering in affected persons. The author remarks: “…it is not a brain that is ill, but a person. In the language of the neurosciences, the concept ‘person’ is frequently replaced with ‘brain’, but it is not the brain that is in touch with the surrounding world, it is the human being whose existing thrives or falls apart”. At the end of his book the author summarizes that view: “The meaning and importance of psychological suffering is not found in the brain, but in the attitudes people have in evaluating their experiences and in the verbal communication between people and their culture.”

Hell has written a book that is a true scientific and philosophic master-piece.

-- Raymond Battegay, M.D., emerited professor of psychiatry of the University of Basel/Switzerland

Excerpts:

The significance of soulish experience in modern life
becomes especially obvious in light of the growing culture of experience, in
which the unemotional quality of even impressive technological “virtuality” is
confronted by a hunger for more intense personal experience. A geometrically
progressive increase in hazardous treks, extreme sports, stock market gambles,
gambling itself, and talk shows that feature explosive emotions obviously
expresses a universal longing for an intensification of experience. The modern
world’s hunger for experience is often glibly called a symptom of superficial
craving for “happy events.” However, this hunger also represents a powerful
reaction against any process that reduces our society to the merely technical
and rational, and thus can be viewed as a desperate attempt to amplify bodily
experience rather than see oneself as a mechanistic unit that simply absorbs
information.

Recently, a hypothesis pertaining to risk-compensation was
developed based on the observation that humans require a certain degree of
intensity of experience in order to feel comfortable. This hypothesis contends
that one instinctively takes risks when one’s sensory systems are
insufficiently challenged. In other words, when the daily routine seems too
casual, or perhaps too secure in terms of material needs, people may
deliberately stir up risk to evoke a thrill. In this way, the sort of suspense
found in movies is courted as a thrilling experiment in one’s life; in order to
experience oneself more intensively, the body is challenged to extreme limits
in sports, or is even disfigured and decorated by piercing and tattooing. Who would have imagined forty years ago that
people would voluntarily drop three hundred feet on a rope, brave torrents in
rafts, climb the walls of skyscrapers, or steal from stores for sport? Whether
by altering the body, using drugs, or unprotected sex, we see others try again
and again to heighten their experience of life. The thrill that they seek
corresponds directly to a bodily soulish experience, since physical stimulation
and the soulish experience of danger result in a mixture of fear and pleasure.
This hunger for intense experience, for a “high,” does not arise casually.
Indeed, seeking the intoxication and intensity of high risk threatens to become
a way of life unless – according to Peter Sloterdiyk – such people
are capable of sensing spaces within themselves of which physics know nothing.
When security based on one’s foundation in life fails, and the traditional
sense of how things came about can no longer be perceived, people begin to
create a sense of themselves in which external events are substituted for
internal experience. These artificially provoked episodes of fear, pleasure and
pain eventually can replace the kind of inward-directed search that once found
heart’s ease in the silence within.

This new way of searching for one’s sense of being seems
typical for an era characterized by mobility and flexibility, and in which
continuity and faithfulness are no longer considered enduring values.

Chapter 1, "1. Homo Sentiens Newly Discovered," p. 30 f.

. . .

One cannot expect that the soul can be caught like an image
in a mirror. The long list of theological, psychological, psychoanalytic and
neurobiological attempts to establish a reliable image of the soul can fairly
be seen as fruitless. In effect, the positivistic mirror of the soul is
shattered. Recognizing the failure to establish a dependable representation of
the soul, we must resume the search at the point where the soulish manifests itself:
in personal experience. However, one must not attempt to do this by positing
the representation of the experience as something absolute, but rather by
carefully avoiding the temptation to draw sharp lines, instead paying close
attention to the boundaries in which the soulish shows itself in all its
diversity. This manner of experiencing what makes each person unique and
different should not be allowed to play a secondary role in psychology and
psychiatry. It must not be swept under the carpet in favor of observable
behavior and measurable organic change.

[p. 46 f.]

. . .

This book began with the basic thought that it is only the
subjective experience of an ego — the first person perspective —
together with the third person perspective, i.e., the view of a ‘generalized
third,’ that makes one human. Any attempt to reduce humans to one or the other
viewpoint makes them into either robots or spirit beings. Subjective experience
eludes definition, because it cannot be made into a thing.

Yet we speak of people’s experience, feeling and acting,
meaning the intangible beyond which one cannot probe, that which makes human
beings Individuals. While their actions characterize individuals’ ethics, it is
their feelings that establish humans’ orientation in the world. Perceiving and
feeling are the very foundations of any manner of orientation.

There is good reason to place actions, and therefore ethics,
in the center of our thinking about human beings, thereby developing a
philosophical and religious image of the world similar to the one Jewish
philosopher Emmanuel Lévinas formed so impressively. In the way they shape our
inner orientation and influence our attitudes toward the external world,
perception and feeling are in the foreground of medical and psychiatric
questions. Psychiatric problems can develop whenever a person’s perceptions and
feelings collide with value systems that render one’s experience questionable.

Chapter 4, "The Body of the Soul is Emotional," p. 182

. . .

Even though there are currently no doubts that human
behavior is based on physicochemical processes in the brain, the question
nevertheless remains whether it is sufficient in understanding human personal
“soulish” experience to recognize neuronal processes, or if additional
conditions of biological, psychological and social nature are required. One principal
argument in favor of this wider inquiry comes from the field of brain research
itself, because the development of the brain (within genetic limits) has been
shown to depend on environmental influences and life experiences. The brain is
in no way a static organ; it is an adaptable organ that accommodates its
exquisite structure to outside influences. Thus it has been possible to show,
first with apes, then with human beings, that persistent stimulation of the
fingertips, or ongoing finger movements (such as playing the violin), leads
within several weeks to the enlargement of those areas of the cortex that are
responsible for movements of the fingers. Other studies have shown that damage
to the speech centers in childhood can be partially compensated, as long as the
speech functions of the damaged areas were not yet fixed.

We must remember that the sprouting and interconnecting of
brain cells depends on biographical developments and learning experiences, and
that taxing environmental factors (such as stress) have an enormous influence
on the microanatomy and neurophysiology of various brain-centers. Because of
this, it would be premature to casually conclude that mental illnesses are
diseases of the brain, since the changes in the brain that produce illness
could also be expressing the circumstances and experiences in the affected
person’s life.

Even more important than expanding the scope of the
neuroscience to include environmental influences is the recognition that
personal “soulish” experience cannot entirely be reduced to neurophysiological
processes. Subjective experience contains an additional meaning, and this can
be understood only by reflecting on the cultural background. As American
philosopher Hilary Putnam puts it, “Meaning is not located inside the head.”
Meaning is contained in language, which comes from the relationship of people
and the dialogue with their surroundings.

Psychological disorders have the unusual quality of being
characterized mainly (sometimes exclusively) by subjective experience and the
meaning given to it. They manifest as anxieties, compulsions, depressions,
deceptive sense perceptions, confused speech, excitement and – more and
more frequently – self-inflicted injuries or eating disorders. This is
the kind of suffering that leads one to psychiatrists.

Professor Dr. med. Daniel Hell (1944) was Director of the University Hospital of Psychiatry in Zürich, the famous Burghölzli, and Professor of Clinical Psychiatry at the University of Zürich until 2009. He currently directs the Anxiety and Depression Center at Privatklinik Hohenegg in Meilen. Daniel Hell’s scientific research has focused primarily on depression and other emotional problems and several of his published books have become best- and long-sellers in German. His work has been translated into six languages.